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www.nhs.uk
February 2020
Commissioning for Quality and
Innovation (CQUIN)
CCG Indicator Specifications for 2019-2020
Publishing Approval Reference Number 000050
NHS England and NHS Improvement – Working together for the NHS
www.nhs.uk 2
ContentsSection Slide
1. Introduction 3
2. Indicator Values 4
3.
3a.
3b.
3b.
3b.
Payment:
Thresholds and quarters
Calculating performance
Calculating payments
Reconciling payment
5 - 9
6
7
8
9
4.i.
4.i.a.
4.i.b.
4.i.c.
4.i.d.
Understanding Performance:
Monitoring performance
Collecting quarterly data: approach to auditing
Collecting quarterly data: defined sampling frame
Collecting quarterly data: undefined sampling frame
10 - 12
10
11
12
12
4.ii.
4.ii.a.
4.ii.b.
4.ii.c.
4.ii.d.
4.ii.e.
4.ii.f.
Data Collection and Reporting:
Indicators that require collection
Collection schedule
Access and use
Submitting data
Data revisions
Managing users
13-17
14
14
15
16
16
17
5.
5a.
5b.
5c.
5d.
CQUIN Indicators:
Prevention of Ill Health
Mental Health
Patient Safety
Best Practice Pathways
18 - 39
18
25
30
33
www.nhs.uk 3
1. Introduction
The 2019/20 CCG CQUIN scheme contains 11 indicators, aligned to the 4 key areas as
illustrated below. This Annex sets out the technical specification for each of the indicators in
the scheme outlining how each indicator will be measured, how performance will be assessed
and paid, as well as links to relevant supporting documents. This document should be read in
conjunction with the 2019/20 CQUIN Guidance, which provides information on the rationale
for each CQUIN and details of the scheme’s structure and value.
Prevention of Ill Health
• Antimicrobial Resistance –Lower Urinary Tract Infections in Older People & Antibiotic Prophylaxis in Colorectal Surgery
• Staff Flu Vaccinations
• Alcohol and Tobacco –Screening & Brief Advice
Mental Health
• Improved Discharge Follow Up
• Improved Data Quality and Reporting – Data Quality Maturity Index & Interventions
• IAPT – Use of Anxiety Disorder Specific Measures
Patient Safety
• Three High Impact Actions to Prevent Hospital Falls
• Community Placed PICC Lines Secured Using a SecurAcath Device
Best Practice Pathways
• Stroke 6 Month Reviews
• Ambulance Patient Data at Scene –Assurance & Demonstration
• Same Day Emergency Care –Pulmonary Embolus/ Tachycardia/ Community Acquired Pneumonia
www.nhs.uk 4
2. Indicator ValuesThe majority of CQUINs are comprised of a single indicator that is used to measure performance and against which
100% of payment will be determined. There are 5 CQUINs that contain sub-parts with payment values spread across
these sub parts as outlined in the table below.
Indicator Value (%)
CCG1: Antimicrobial Resistance (AMR)* 100
CCG1a: Antimicrobial Resistance – Lower Urinary Tract Infections in Older People 50
CCG1b: Antimicrobial Resistance – Antibiotic Prophylaxis in colorectal surgery 50
CCG3: Alcohol and Tobacco (A&T) 100
CCG3a: Alcohol and Tobacco - Screening 33
CCG3b: Alcohol and Tobacco – Tobacco Brief Advice 33
CCG3c: Alcohol and Tobacco – Alcohol Brief Advice 33
CCG5: Mental Health Data: 100
CCG5a: Mental Health Data: Data Quality Maturity Index 50
CCG5b: Mental Health Data: Interventions 50
CCG10: Ambulance - Access to Patient Information at Scene 100
CCG10a: Ambulance - Access to Patient Information at Scene (Assurance) 75
CCG10b: Ambulance - Access to Patient Information at Scene (Demonstration) 25
CCG11: Same Day Emergency Care (SDEC) 100
CCG11a: SDEC – Pulmonary Embolus 33
CCG11b: SDEC – Tachycardia with Atrial Fibrillation 33
CCG11c: SDEC – Community Acquired Pneumonia 33
* For providers where CCG1b is not in scope then CCG1a will carry 100% value.
www.nhs.uk 5
3. Payment – based on cumulative performance
at the end of the schemeThe process for calculating performance and payment in this year’s CQUIN scheme has been simplified. Here are the
key principles. These will be explained in more detail, with some illustrative examples over the coming slides.
1. For all indicators this year, payment will be based on a performance assessment undertaken at the end of
the scheme.
2. For most indicators, this payment assessment will be based on the sum of four quarters’ data, with data
collected at the end of each quarter. For some indicators Q1 or Q2 performance has been exempted from
this calculation.
• To work out payment, it is usually the case that you take the sum of the relevant quarterly numerators and
express that as a proportion of the sum of the relevant quarterly denominators. This will give you a ‘%’ and
that is your performance.
• For some indicators, for example those related to the MHSDS, performance will be calculated automatically
by the Mental Health Team at the year end, though for monitoring purposes, information will be available at
more regular intervals to commissioners and providers throughout the year.
• For staff flu, the calculation is as per previous years, based on the number of front line staff, therefore
multiple regular calculations will not be required.
3. Partial payment thresholds have been removed. Instead, there is simply one lower and one upper threshold
for each indicator. Payment is determined by reference to these thresholds. Where the upper threshold is
reached based on the year end assessment, 100% of payment will be earned; where it drops below the
lower threshold, 0% would be earned. Payment is graduated between the two thresholds evenly.
4. NHS England does not mandate a specific approach to paying CQUIN monies to providers during the year
in advance of the final payment assessment. Many CCGs, for example, will choose to pay providers a
regular instalment based on expected earnings requiring this to be reconciled on the basis of actual
performance.
www.nhs.uk 6
3a. Payment: Thresholds and relevant quartersPayment in this year’s scheme will reward providers based on their performance falling between the minimum and
maximum thresholds for each indicator during the applicable period (payment basis). The table below summarises the
relevant thresholds and payment basis that will be used for each of the indicators within the scheme. Assessment
should take place at the end of the scheme and calculated according to the method outlined in Payments:
calculating payments.
Indicator Pay
levels(%)
Payment
basis
Indicator Pay
levels(%)
Payment
basis
CCG1a: AMR– Lower Urinary
Tract Infections in Older People
60 - 90 Q2-4 CCG6: Use of Anxiety Disorder
Specific Measures in IAPT
30 - 65 Q2-4
CCG1b: AMR– Antibiotic
Prophylaxis in colorectal surgery
60 - 90 Q1-4 CCG7: Three high impact
actions to prevent Hospital Falls
25 - 80 Q2-4
CCG2: Staff Flu Vaccinations 60 - 80 Q4 CCG8: PICC lines secured
using a SecurAcath device
70 - 85 Q1-4
CCG3a: A&T- Screening 40 - 80 Q1-4 CCG9: Stroke 6 Month Reviews 35 - 55 Q1-4
CCG3b: A&T– Tobacco Brief
Advice
50 - 90 Q1-4 CCG10a: Ambulance -
(Assurance)
0 - 100 Q1-4
CCG3c: A&T– Alcohol Brief
Advice
50 - 90 Q1-4 CCG10b: Ambulance -
(Demonstration)
0 - 5 Q3-4
CCG4: 72hr follow up post
discharge
50 - 80 Q3-4 CCG11a: SDEC – Pulmonary
Embolus
50 - 75 Q1-4
CCG5a: Mental Health Data: Data
Quality Maturity Index
90 - 95 Q2-4 CCG11b: SDEC – Tachycardia
with Atrial Fibrillation
50 - 75 Q1-4
CCG5b: Mental Health Data:
Interventions
15 - 70 Q3-4 CCG11c: SDEC – Community
Acquired Pneumonia
50 - 75 Q1-4
www.nhs.uk 7
3b. Payments: Calculating Performance
Whilst monitoring will take place on a quarterly basis, performance will be based on the entirety of the relevant period.
• For the majority of indicators, this is usually the whole year (see ‘Payment Basis’ column on Slide 6).
• For a typical scheme that applies to the entire year, the performance will be calculated by adding together the four
numerators and denominators submitted and expressing that as a percentage to get a total figure for the year.
• In the example below, 160 is 40% of 400, so the overall performance figure is 40%
Quarterly monitoring Scheme
Performance
Q1 Q2 Q3 Q4
Num Den Perf
(%)
Num Den Perf
(%)
Num Den Perf
(%)
Num Den Perf
(%)
Num Den Perf
(%)
25 100 25 35 100 35 45 100 45 55 100 55 160 400 40
Quarterly monitoring Scheme
Performance
Q1 Q2 Q3 Q4
Num Den Perf
(%)
Num Den Perf
(%)
Num Den Perf
(%)
Num Den Perf
(%)
Num Den Perf
(%)
N/A N/A N/A 25 100 25 55 100 55 75 100 75 155 300 52
• In the example below, performance was on the basis of Q2 – Q4, so here we add together the three numerators and
express that as a proportion of the sum of the three denominators.
• 155 is 52% of 300, so the performance figure is 52%
www.nhs.uk 8
3b. Payments: Calculating Payment
The previous slide explained how to arrive at the overall performance result for the indicators, but how does that relate
to the actual CQUIN payment that a provider will earn? Payment in this year’s scheme will reward providers based on
their performance falling between each indicator’s minimum and maximum thresholds, using the following formula.
Payment calculation: (Performance – Min) / (Max – Min) = Payment value
Quite simply, all of the indicators have a target performance level that we refer to as ‘max’ on all of the indicator
specifications. There is also a ‘min’ level – this is the level at which some level of payment begins to be earned – and
this payment is awarded proportionately based on where performance lands between the ‘min’ and ‘max’ threshold.
Here are some examples to illustrate this process more clearly.
• Example 1: Here, the performance level that the provider has achieved is 40%. This is below the ‘min’ threshold of
50% so no payment has been earned.
• Example 2: Here, the performance level that the provider has achieved is 63%. This is between the ‘min’ (25%) and
‘max’ (80%) thresholds and the calculation shows us that this equates to an earning of 69% of the payment available
(69% of £100k = £69k).
• Example 3: Here, the performance level that the provider has achieved is 72%. This is above the ‘max’ threshold of
70% so the provider earns the full potential amount associated with that indicator. Payment is capped at 100% so
100% of £100k = £100k.
Threshold Calculation Potential
CQUIN
indicator
Value
Payment
Exam
-ple
Min
(%)
Max
(%)
Perform-
ance
(Performance – Min) / (Max –
Min) = Payment value % Calculation (£) £
1 50 90 40% (40% - 50%) / (90% - 50%) = -25% £100k 0% 100k x 0% = 0 0k
2 25 80 63% (63% - 25%) / (80% - 25%) = 69% £100k 69% 100k x 69% = 69 69k
3 30 70 72% (72% - 30%) / (70% - 30%) = 105% £100k 100% 100k x 100% = 100 100k
www.nhs.uk 9
3b. Payments: Reconciling Payment
Example Potential
CQUIN
Indicator
Value
In-year Payments (£,000) End of
Scheme
Perfor-
mance
(%)
Due
based on
Perfor-
mance
(£,000)
Reconciliation
Q1 Q2 Q3 Q4 Total Calculation (+ve =
overpaid, -ve =
underpaid
Amount
overpaid
Amount
underpaid
1 £100k 25 25 25 25 100 81% £81k 100 – 81 = 19 £19k
2 £100k 25 25 50 81% £81k 50 – 81 = -31 £31k
NHS England do not mandate a specific approach to paying CQUIN monies to providers. Many CCGs, for example, will
choose to pay a regular amount throughout the year, this is fine. In all instances though, the assessment of actual
performance should take place at the end of the year and any over/ under payment should be reconciled on
the basis of actual performance.
So, how is any reconciliation requirement assessed?
The two examples below show scenarios where regular CQUIN payments have been paid throughout the year against
an indicator, where the provider achieved a performance level which meant they had earned 81% of the potential
CQUIN value of £100k (81% of £100k = £81k)
• Example 1: The CCG has made four quarterly payments of £25k, totalling £100k. The provider actually earned £81k,
so the CCG has overpaid by £19k.
• Example 2: The CCG has made two payments of £25k, totalling £50k. The provider actually earned £81k, so the
CCG has underpaid by £31k.
www.nhs.uk 10
4.i. Understanding Performance4.i.a. Monitoring performance
There are two broad sources for the CQUIN indicator data:
• existing published data that are readily available; and
• data that will be collected via a national CQUIN collection.
For each indicator, quarterly data will be available from one of these sources in order to allow performance monitoring by
both commissioners and NHS England. The detail about each source is set out in the ‘Data Source(s) & Reporting’ section
of each indicator’s specification. For published data, the data source has been identified and links provided to allow ready
access to the data – for example Flu vaccinations data. Indicators that require data submission to the national CQUIN
collection are identified by the source being the ‘national CQUIN collection‘. With the exception of CCG10b: Ambulance -
(Demonstration) this will require supplying data on a quarterly basis by auditing relevant records, such as case notes.
The next section provides more information about the auditing approaches to be adopted. It is recommended that, where
available, (clinical) audit professionals within each service are contacted to assist with selecting from the approaches
detailed below and to ensure local protocols are met.
4.i.b. Collecting quarterly data: approach to auditing
In circumstances where both numerator and denominator data are locally available via searchable electronic patient
records, then all patient records (that match the denominator) should be audited for performance monitoring and
assessment. Otherwise, sampling of records will be required to allow performance monitoring and assessment. The
auditing approach will be determined by the ability to identify the population of interest (sampling frame) from electronic or
paper case notes. A minimum sample of 100 records meeting the criteria are required from each quarter. Where the total
cohort is less than 100 patients then all records should be audited. If information can be provided readily for all relevant
records, it should be provided in preference to auditing.
One hundred records has been chosen as a balance between burden and robust measuring of performance – smaller
sample sizes would result in greater uncertainty about performance and potentially payments that do not accurately reflect
true performance.
www.nhs.uk 11
4.i. Understanding Performance
4.i.b. Collecting quarterly data: standard approach to auditing cont….
One of the approaches detailed in sections 4c and 4d should be chosen and maintained, based on the CQUIN and
local circumstances of the trust. Where possible a defined sampling frame should be established to allow auditing of the
indicator.
4.i.c. Collecting quarterly data: defined sampling frame.
If all cases can be readily identified (i.e. those in the denominator) via searchable electronic patient records or via paper
case notes then quarterly audits of a minimum, random sample of 100 records meeting the criteria are required. An
example might be where all cases notes in a given department are relevant.
Trusts must select ONE of the following methods of random sampling and maintain this method throughout the scheme:
1) True randomisation: every case within the sampling frame needs to be assigned a unique reference number
consecutively from 1 to x. Then a random number generator (e.g. http://www.random.org/) is used with 1 and x
setting the lower and upper bounds. 100 cases are then identified using the random number generator from within
these bounds.
2) Quasi-randomisation: every case within the sampling frame needs to be assigned a unique reference number
consecutively from 1 to x but only after the cases have been ordered in a way that doesn’t have any clinical
significance, for example, using the electronic patient ID number. A repeat interval ‘i’ is then calculated by i=x/100,
so that every ‘i’th case will be selected after the first case has been randomly generated between 1 and i.
For example, for a sampling frame of 1,000 cases, i=1,000/100 =10. So the first case will be randomly selected
between 1 and 10 and then the 10th case from this will be used. For example. cases 7, 17, 27, 37, 47… will be chosen.
www.nhs.uk 12
4.i. Understanding Performance
4.i.d. Collecting quarterly data: undefined sampling frame.
If the sampling frame (i.e. the denominator) cannot be fully identified via searchable electronic patient records or via
paper case notes, but instead requires reviewing each set of case notes, then it may not be feasible to use random
sampling methods. Instead a quarterly audit by Quota sampling 100 records is required. Quota sampling is a non-
random approach to case selection, where case notes are systematically searched to identify those that match the
denominator. The approach is convenient and requires additional care to ensure the sample is representative. Below
are examples of how quota sampling could be implemented by trusts. We acknowledge that the individual
circumstances of each trust will determine the exact approach adopted. Quota sampling should ideally be avoided in
preference for a random approach (see section 4c).
Example quota sampling methods:
• Patient ID: If case notes are ordered purely by a randomly assigned patient ID then case notes can be searched
consecutively from any position until 100 cases are identified.
• Chronological: If cases are chronologically ordered then case notes should be selected in a way that ensures the
period is well represented. For example, searching through cases from day 1 of the quarter until a case is
identified, and then repeating for each subsequent day of the quarter. This can then be repeated from day 1 until
100 records have been identified.
Similarly, where cases are categorised or split into groups (e.g. by consultant specialty or ward) then auditing should
take this in to account in order to best ensure the sample is representative. For example, if cases are relevant from
across several wards, then it is important that cases from each ward form part of the sample.
www.nhs.uk 13
4.ii. Data Collection and Reporting
For the 2019/20 CQUIN scheme we are undertaking a proof of concept approach to data collection and reporting,
working with a new partner, NetSolving and using their Case Capture tool to collect CQUIN data. This will replace the
SDCS CQUIN collection previously operated via NHS Digital.
This new approach adheres to the principles of simplicity and effectiveness and is aimed at enhancing the user
experience when collecting and monitoring CQUIN performance. The new method should make it easier to upload data
and navigate through the site, providing improved system functionality and better-quality data with improved built-in
validation checks.
Furthermore, throughout the year, there will be a renewed focus on the provision of improved, flexible reporting on
CQUIN performance for providers, regions, CCGs and national teams, offering an ability to understand performance
across a range of cohorts. This will all be made available via the Case Capture platform.
Alongside the collection of data for those indicators where there is no existing source (see 4.ii.a.), Case Capture
reporting will also include CQUIN data collected via other national sources and will serve as a single location for
reviewing CQUIN performance. The importing of this data will be managed centrally. This comprehensive dataset will be
the optimal source for the local CQUIN performance reporting required under SC38.5 of the NHS Standard Contract.
In order to provide a complete set of data, drawing in a range of other national sources in the way that has been
described above, it is important that each quarter providers identify all CQUIN indicators they are required to deliver,
including those that they are directly submitting data for through Case Capture. This will ensure that data for those
indicators where data is taken from existing sources is imported accurately and presented alongside the submitted data
to present a comprehensive view of performance.
Those providers that have CCG contracts that apply to different services and undertake CCG3a-c & 7 need to supply
data for each contract. For example, acute services and community services provided for the same CCG under different
contracts will need to supply data against each for CCG7.
www.nhs.uk 14
4.ii. Data Collection and Reporting
4.ii.a. Indicators that require collection
The CQUIN data that will be collected via this new platform are listed in the table below. The indicator specifications
describe the specific data items that will need to be calculated and submitted.
4.ii.b. Collection schedule
The data collection will operate in line with the schedule below:
Submission Window Quarter 1 Quarter 2 Quarter 3 Quarter 4
Opens July 15th 2019 October 14th 2019 January 13th 2020 April 13th 2020
Closes August 16th 2019 November 15th 2019 February 14th 2020 May 15th 2020
CCG3a Alcohol and Tobacco - Screening
CCG3b Alcohol and Tobacco – Tobacco Brief Advice
CCG3c Alcohol and Tobacco – Alcohol Brief Advice
CCG7 Three high impact actions to prevent Hospital Falls
CCG8 Community Placed PICC lines secured using a SecurAcath device
CCG10b Ambulance - Access to Patient Information at Scene (Demonstration)
CCG11a SDEC – Pulmonary Embolus
CCG11b SDEC – Tachycardia with Atrial Fibrillation
CCG11c SDEC – Community Acquired Pneumonia
www.nhs.uk 15
4.ii. Data Collection and Reporting
4.ii.c. Access and use
Case Capture is an online tool, accessible 24 hours a day for anyone with an internet connection. All users who had
previously been registered for the 2018/19 CQUIN collection will be invited to submit data via Case Capture. These
users have been set up with privileges that allow them the ability to invite colleagues to submit data on behalf of the
provider.
Newly added users as identified above will receive an email from ‘noreply@netsolving.com’. Please follow the prompts
in that email to set up your password. Check your spam folder if you cannot find it in your inbox.
If you have not received a registration email and believe that you should, please contact your CQUIN lead to determine
whether they are able to add you to Case Capture – information on managing users is provided in section 4.ii.f.
If you believe that nobody within your provider has been granted access to Case Capture and you need to submit data
for the CQUINs listed on the previous page, please contact e.cquin@nhs.net with the following information:
1. Email subject: CQUIN data collection: User Check
2. Full name
3. Provider name
4. Email address
Once you have been added successfully, your registration email will contain the following:
Link: https://data.casecapture.com/
Username: your email address joe.bloggs@hospital.nhs.uk
Password: Create strong password with numerical and characters.
2 Factor Authentication: When you log-in for the first time you will be sent a 6 digit code to your email, enter this into
the box.
www.nhs.uk 16
4.ii. Data Collection and Reporting
4.ii.d. Submitting data
Submitting data via Case Capture is simple and intuitive.
1. Click ‘edit’ (pencil icon) on the right hand side of the ‘CQUINs study’ to navigate to the record management screen.
2. Within the record management screen click “Add record” to start entering data.
3. You will need to select all of the CQUINs that you are expected to deliver.
4. Ensure all sections are green before completing. You are able to edit it later once it has been saved.
5. Ensure you click ‘Save’ before exiting the data collection.
6. Once you have completed the record and you can see it saved as green in the record management screen, click the
padlock button to lock the record, prior to the collection window closing. Once locked you will no longer be able to
make any changes to your record so please ensure that you have reviewed and are content with your submission
prior to locking your record.
N.B. Only locked records will be considered finalised and used for national reporting. Unlocked records will be
considered as draft and not used. For housekeeping, it is recommended that any unused, draft records that are not
locked each quarter are deleted.
Please be aware that, whilst FAQs and helpful information (e.g. brief numerator and denominator descriptions) are
available within Case Capture, the detailed specifications held within this document and the contacts named within
these specifications should be the primary source of information for any questions about specific CQUIN indicators.
4.ii.e. Data Revisions
By exception, revisions can be submitted via Case Capture according to the timetable below. When submitting a
revision, the email address of the responsible person in the CCG who has been informed of the revision must be
provided. Without this confirmation, a revision is not able to be submitted.
Revisions Window Quarter 1 Quarter 2 Quarter 3 Quarter 4
Opens November 25th 2019 February 24th 2020 May 25th 2020 June 8th 2020
Closes December 6th 2019 March 6th 2020 June 5th 2020 June 19th 2020
www.nhs.uk 17
4.ii. Data Collection and Reporting
4.ii.f. Managing users
A single user from each provider has privileges that allow them to invite colleagues to submit data on behalf of the
provider. This user has ‘Administrator’ privileges within Case Capture.
In order to add an additional user from your provider, “Administrators” must follow the ‘Add User’ link on the landing
page. You will need the email address of the user you are wishing to add, and you will need to determine the level of
access that this user should have. For example, they may be able to upload data or have access to view reports. We
recommend that just one or two individuals per site are provided with ‘Administrator’ privileges.
We recommend that ‘Writer’ access which allows editing of data and ‘Importer’, are limited.
www.nhs.uk 18
5a. CQUIN Indicators: Prevention of Ill Health
CCG1: Antimicrobial Resistance
CCG1a: Antimicrobial Resistance – Lower Urinary Tract Infections in
Older People
19
CCG1b: Antimicrobial Resistance – Antibiotic Prophylaxis in Colorectal
Surgery
20
CCG2: Staff Flu Vaccinations 21
CCG3: Alcohol and Tobacco
CCG3a: Alcohol and Tobacco - Screening 22
CCG3b: Alcohol and Tobacco – Tobacco Brief Advice 23
CCG3c: Alcohol and Tobacco – Alcohol Brief Advice 24
www.nhs.uk
CCG1a: Antimicrobial Resistance – Lower Urinary
Tract Infections in Older People
19
Data Source(s) & Reporting
Data should be submitted quarterly to PHE via the online submission portal. An auditing
tool will be available in supporting guidance. See sections 4b-d for details about auditing.
Data will be made publicly available on the PHE Fingertips AMR Portal approximately 9
weeks after each quarter.
Description
Achieving 90% of antibiotic prescriptions for lower UTI in older people meeting NICE
guidance for lower UTI (NG109) and PHE Diagnosis of UTI guidance in terms of diagnosis
and treatment.
Numerator
Of the denominator, the number where the 4 audit criteria for diagnosis and treatment
following PHE UTI diagnostic and NICE guidance (NG109) are met and recorded:
1. Diagnosis of lower UTI based on documented clinical signs or symptoms
2. Diagnosis excludes use of urine dip stick
3. Empirical antibiotic prescribed following NICE Guideline (NG109)
4. Urine sample sent to microbiology
Denominator
Total number of antibiotic prescriptions for all patients, aged 65+, with a diagnosis of lower
Urinary Tract Infection (ICD-10 codes: N39.0 and N30.0. ED code 27. SNOMED code
68226007)
Exclusions
Recurrent UTI (See NICE guidance NG112) where management is antibiotic prophylaxis,
pyelonephritis, catheter associated UTI, sepsis
Accessing support
Policy Lead
Elizabeth Beech
Elizabeth.beech@nhs.net
Supporting Documents
Antimicrobial Resistance –
Urinary Tract Infections
supporting guidance
PHE UTI Diagnosis Guideline
NICE Guidance NG109
Services in scope
Acute
Payment levels
Minimum: 60%
Maximum: 90%
Scope: Q1 Q2 Q3 Q4
www.nhs.uk
CCG1b: Antimicrobial Resistance – Antibiotic
Prophylaxis in Colorectal Surgery
20
Data Source(s) & Reporting
Data should be submitted quarterly to PHE via the online submission portal. An auditing tool will be available in the supporting guidance. See sections 4b-d for details about auditing.
Data will be made publicly available on the PHE Fingertips AMR Portal approximately 9 weeks after each quarter.
Description
Achieving 90% of antibiotic surgical prophylaxis prescriptions for elective colorectal
surgery being a single dose and prescribed in accordance to local antibiotic guidelines.
Numerator
Of the denominator, the number of prophylactic single dose antibiotic prescriptions that
meet the NICE NG125 guidance regarding the choice of antibiotic.
Denominator
Total number of audited antibiotic prescriptions for inpatients, aged 18+, undergoing
surgical prophylaxis for elective colorectal surgery*
*relevant procedural coding is detailed in the supporting guidance.
Accessing support
Policy Lead
Elizabeth Beech
Elizabeth.beech@nhs.net
Supporting Documents
Antimicrobial Resistance –
Surgical Antibiotic Prophylaxis
supporting guidance
NHSI/PHE audit tool
NICE Guidance NG125
Services in scope
Acute who perform elective colorectal surgery
Payment levels
Minimum: 60%
Maximum: 90%
Scope: Q1 Q2 Q3 Q4
www.nhs.uk
CCG2: Staff Flu Vaccinations
21
Data source(s) & Reporting
Monthly Provider submission (between September and March) to PHE via ImmForm. See:
Guidance
Data will be made publicly available approximately 6 weeks after each quarter.
Description
Achieving an 80% uptake of flu vaccinations by frontline clinical staff.
Numerator
Total number of front line healthcare workers who have received their flu vaccination
between 1 September 2019 and February 28th 2020.
Denominator
Total number of front line healthcare workers.
Exclusions
• Staff working in an office with no patient contact
• Social care workers
• Staff out of the Trust for the whole of the flu vaccination period (e.g. maternity leave,
long term sickness)
NB. Aside from the target, this CQUIN is exactly the same as in the 17/19 Scheme.
Accessing support
Policy Lead
Doug Gilbert
Douglas.gilbert1@nhs.net
Supporting Documents
ImmForm Guidance
Green Book
NICE guidance NG103
Services in scope
Acute, Community, Mental
Health, Ambulance
Payment levels
Minimum: 60%
Maximum: 80%
Scope*: Q1 Q2 Q3 Q4
*Achievement of this CQUIN is determined by the total proportion of frontline healthcare workers vaccinated. It is
not based on average rates of vaccination across quarters but rather the cumulative rate at the end of the year.
www.nhs.uk
CCG3a: Alcohol and Tobacco - Screening
22
Data source(s) & Reporting
Quarterly submission via National CQUIN collection – see sections 4.i. for details about
auditing and 4.ii. for details on data collection and reporting.
Data will be made available approximately 6 weeks after each quarter.
Description
Achieving 80% of inpatients admitted to an inpatient ward for at least one night who are
screened for both smoking and alcohol use.
Numerator
Of the denominator, those screened for both smoking and alcohol risk status and the
results recorded in patient’s record.
Denominator
All *unique patients, aged 18+ who are admitted to an inpatient ward for at least one night
(i.e. length of stay equal to or greater than one).
*Unique is defined as a non-repeat admission of a patient during the duration of the
CQUIN who has not already received the intervention within the period of the CQUIN.
Exclusions
Maternity inpatients (exclude where ‘Epitype’=2,3,4,5 or 6).
Accessing support
Policy Lead
Don Lavoie
Don.Lavoie@phe.gov.uk
Supporting Documents
Alcohol and Tobacco Brief
Interventions E-Learning
programme
Guidance and information
Services in scope
Acute, Community, Mental
Health
Payment levels
Minimum: 40%
Maximum: 80%
Scope: Q1 Q2 Q3 Q4
www.nhs.uk
CCG3b: Alcohol and Tobacco – Tobacco Brief Advice
23
Data source(s) & Reporting
Quarterly submission via National CQUIN collection – see sections 4.i. for details about
auditing and 4.ii. for details on data collection and reporting.
Data will be made available approximately 6 weeks after each quarter.
Description
Achieving 90% of identified smokers given brief advice.
Numerator
Of the denominator, those who are given brief advice as outlined in the Alcohol and
Tobacco Brief Interventions E-learning programme - including an offer of Nicotine
Replacement Therapy (whether or not this offer had been taken up).
Denominator
All eligible patients who have been recorded as smokers during screening.
Accessing support
Policy Lead
Don Lavoie
Don.Lavoie@phe.gov.uk
Supporting Documents
Alcohol and Tobacco Brief
Interventions E-Learning
programme
Guidance and information
Services in scope
Acute, Community, Mental
Health
Payment levels
Minimum: 50%
Maximum: 90%
Scope: Q1 Q2 Q3 Q4
www.nhs.uk
CCG3c: Alcohol and Tobacco – Alcohol Brief Advice
24
Data source(s) & Reporting
Quarterly submission via National CQUIN collection – see sections 4.i. for details about
auditing and 4.ii. for details on data collection and reporting.
Data will be made available approximately 6 weeks after each quarter.
Description
Achieving 90% of patients identified as drinking above low risk levels, given brief advice or
offered a specialist referral.
Numerator
Of the denominator, those who are given brief advice as outlined in the Alcohol and
Tobacco Brief Interventions E-learning programme, or offered a specialist referral if the
patient is potentially alcohol dependent.
Denominator
All eligible patients who have been recorded as drinking above the low risk levels.
Accessing support
Policy Lead
Don Lavoie
Don.Lavoie@phe.gov.uk
Supporting Documents
Alcohol and Tobacco Brief
Interventions E-Learning
programme
Guidance and information
Services in scope
Acute, Community, Mental
Health
Payment levels
Minimum: 50%
Maximum: 90%
Scope: Q1 Q2 Q3 Q4
www.nhs.uk 25
5b. CQUIN Indicators: Mental Health
CCG4: 72hr follow up post discharge 26
CCG5: Mental Health Data 27
CCG5a: Mental Health Data: Data Quality Maturity Index 27
CCG5b: Mental Health Data: Interventions 28
CCG6: Use of Anxiety Disorder Specific Measures in IAPT 29
www.nhs.uk
CCG4: 72hr follow up post discharge
26
Data Source(s) & Reporting
Routine provider submission to the Mental Health Services Data Set (MHSDS).
Monthly provider level data will be available approx. 12 weeks after each period – details
will be provided via the ‘Mental Health CQUIN’ FutureNHS Collaboration Platform.
Description
Achieving 80% of adult mental health inpatients receiving a follow-up within 72hrs of
discharge from a CCG commissioned service.
Numerator
Of the denominator, those who have a follow up within 72hrs (commencing the day after
discharge).
Denominator
Number of people discharged from a CCG commissioned adult mental health inpatient
setting.
Exclusions
Details will be provided via the ‘Mental Health CQUIN’ FutureNHS Collaboration Platform.
Accessing support
Policy Lead
Belinda Yeldon
England.MHCQUIN@nhs.net
Supporting Documents
Available from the ‘Mental
Health CQUIN’ FutureNHS
Collaboration Platform. Please
email the policy lead above to
gain access.
Services in scope
Mental Health
Payment levels
Minimum: 50%
Maximum: 80%
Scope: Q1 Q2 Q3 Q4
www.nhs.uk
CCG5a: Mental Health Data Quality: MHSDS Data
Quality Maturity Index
27
Data Source(s) & Reporting
Routine provider submission to the Mental Health Services Data Set (MHSDS).
The MHSDS monthly data quality reports include granular provider level data on the data
items included in the MHSDS DQMI. Published MHSDS data
Monthly provider level data will be available approx. 12 weeks after each period – details
will be provided via the ‘Mental Health CQUIN’ FutureNHS Collaboration Platform.
Description
Achieving a score of 95% in the MHSDS Data Quality Maturity Index (DQMI).
Indicator
The MHSDS DQMI score is an overall assessment of data quality for each provider, based
on a list of key MHSDS data items. The MHSDS DQMI score is defined as the mean of all
the data item scores for percentage valid & complete, multiplied by a coverage score for
the MHSDS. The full definition and DQMI data reports can be found at: DQMI webpage
Data Items
The MHSDS Data items included in the DQMI are outlined in the Changes to the DQMI.
Accessing support
Policy Lead
Belinda Yeldon
England.MHCQUIN@nhs.net
Supporting Documents
Available from the ‘Mental
Health CQUIN’ FutureNHS
Collaboration Platform. Please
email the policy lead above to
gain access.
Services in scope
Mental Health (MH trusts only)
Payment levels
Minimum: 90%
Maximum: 95%
Scope: Q1 Q2 Q3 Q4
www.nhs.uk
CCG5b: Mental Health Data Quality: Interventions
28
Data Source(s) & Reporting
Routine provider submission to the Mental Health Services Data Set (MHSDS).
Monthly provider level data will be available approx. 12 weeks after each period – details
will be provided via the ‘Mental Health CQUIN’ FutureNHS Collaboration Platform.
Description
Achieving 70% of referrals where the second attended contact takes place between Q3-4
with at least one intervention (SNOMED CT procedure code) recorded between the
referral start date and the end of the reporting period.
Numerator
Of the denominator, the referrals with at least one intervention* (SNOMED CT procedure
code) recorded between the referral start date and the end of the reporting period.
Denominator
The number of referrals that receive their second attended contact in Q3-4 2019/20.
*A condition of this CQUIN is that providers demonstrate a range of interventions over the
course of Q3 – Q4. Any provider who is found to be only using one intervention code will
receive no payment.
Accessing support
Policy Lead
Belinda Yeldon
England.MHCQUIN@nhs.net
Supporting Documents
Available from the ‘Mental
Health CQUIN’ FutureNHS
Collaboration Platform. Please
email the policy lead above to
gain access.
NHS Digital SNOMED CT
Browser
MH SNOMED Website
Specific Pathway Guidance on
SNOMED CT Intervention
Codes
Services in scope
Mental Health (MH trusts only)
Payment levels
Minimum: 15%
Maximum: 70%
Scope: Q1 Q2 Q3 Q4
www.nhs.uk
CCG6: Use of Anxiety Disorder Specific Measures in
IAPT
29
Data Source(s) & Reporting
Routine provider submission to the Improving Access to Psychological Therapies (IAPT)
Data Set
Monthly provider level data will be available approx. 12 weeks after each period – details
will be provided via the ‘Mental Health CQUIN’ FutureNHS Collaboration Platform.
Description
Achieving 65% of referrals with a specific anxiety disorder problem descriptor finishing a
course of treatment having paired scores recorded on the specified Anxiety Disorder
Specific Measure (ADSM).
Numerator
Of the denominator, the referrals that had paired scores recorded on the specified ADSM.
Denominator
The number of referrals with a specific anxiety disorder problem descriptor*, where the
course of treatment was finished and where there were at least two attended treatment
appointments.
*This includes 6 disorders: Obsessive Compulsive Disorder, Social Phobias, Health
Anxiety, Agoraphobia, Post Traumatic Stress Disorder, Panic Disorder.
Accessing support
Policy Lead
Belinda Yeldon
England.MHCQUIN@nhs.net
Supporting Documents
Available from the ‘Mental
Health CQUIN’ FutureNHS
Collaboration Platform. Please
email the policy lead above to
gain access.
IAPT manual
Services in scope
IAPT Services
Payment levels
Minimum: 30%
Maximum: 65%
Scope: Q1 Q2 Q3 Q4
www.nhs.uk 30
5c. CQUIN Indicators: Patient Safety
CCG7: Three high impact actions to prevent Hospital Falls 31
CCG8: Community Placed PICC lines secured using a SecurAcath
device
32
www.nhs.uk
CCG7: Three high impact actions to prevent Hospital Falls
31
Data Source(s) & Reporting
Quarterly submission via National CQUIN collection – see sections 4.i. for details about
auditing and 4.ii. for details on data collection and reporting.
Data will be made available approximately 6 weeks after each quarter.
Description
Achieving 80% of older inpatients receiving key falls prevention actions
Numerator
Number of patients from the denominator where all three specified falls prevention actions are met and recorded:
1. Lying and standing blood pressure recorded at least once.
2. No hypnotics or antipsychotics or anxiolytics given during stay OR rationale for giving hypnotics or antipsychotics or anxiolytics documented (British National Formulary defined hypnotics and anxiolytics and antipsychotics).
3. Mobility assessment documented within 24 hours of admission to inpatient unit stating walking aid not required OR walking aid provided within 24 hours of admission to inpatient unit.
Denominator
Admitted patients aged over 65 years, with length of stay at least 48 hours.
Exclusions
• Patients who were bedfast and/or hoist dependant throughout their stay.
• Patients who die during their hospital stay.
Accessing support
Policy Lead
Julie Windsor
patientsafety.enquiries@nhs.n
et
jwindsor@nhs.net
Supporting Documents
Falls Prevention Resources
Services in scope
Acute, Community
Payment levels
Minimum: 25%
Maximum: 80%
Scope: Q1 Q2 Q3 Q4
www.nhs.uk
CCG8: Community Placed PICC lines secured using a
SecurAcath device
32
Data Source(s) & Reporting
Quarterly submission via National CQUIN collection – see sections 4.i. for details about
auditing and 4.ii. for details on data collection and reporting.
Data will be made available approximately 6 weeks after each quarter.
Description
Achieving 85% of community- placed peripherally inserted central catheters (PICC) lines secured using a SecurAcath device.
Numerator
Of the denominator, the number of Patients with a PICC line secured by a SecurAcath device.
Denominator
Patients with a PICC line inserted within a community setting and in place for more than 15 days.
Exclusions
• Patients sensitive to nickel.
• Peripherally inserted central catheters in place for 15 days or less.
Note
This CQUIN does not incentivise a change of securing device to PICC lines after the patient is discharged to the community.
Accessing support
Policy Lead
Stephanie Heath
england.innovation@nhs.net
Supporting Documents
NICE guidance on SecurAcath
for securing percutaneous
catheters - MTG34
Services in scope
Community
Payment levels
Minimum: 70%
Maximum: 85%
Scope: Q1 Q2 Q3 Q4
www.nhs.uk 33
5d. CQUIN Indicators: Best Practice Pathways
CCG9: Six Month Reviews for Stroke Survivors 34
CCG10: Ambulance - Access to Patient Information at Scene
CCG10a: Ambulance - Access to Patient Information at Scene
(Assurance)
35
CCG10b: Ambulance - Access to Patient Information at Scene
(Demonstration)
36
CCG11: Same Day Emergency Care
CCG11a: SDEC – Pulmonary Embolus 37
CCG11b: SDEC – Tachycardia with Atrial Fibrillation 38
CCG11c: SDEC – Community Acquired Pneumonia 39
www.nhs.uk
CCG9: Six Month Reviews for Stroke Survivors
34
Data Source(s) & Reporting
Data provided to the Sentinel Stroke National Audit Programme (SSNAP). See Guidance
and Published data
Description
Achieving 55% of eligible stroke survivors receiving a six month follow up within 4-8
months of their stroke.
Numerator:
Number in the denominator who had a six month follow-up within 4 – 8 months of their
stroke. (SSNAP database variable M2.2).
Denominator:
Number of patients due for follow-up based on when the patient was admitted or when the
follow-up was completed (SSNAP database variable M1.1).
Exclusions
• Died whilst on the stroke care pathway (SSNAP database variable M2.4).
• 6 month reviews that took place before 4 months or after 8 months of the stroke.
Accessing support
Policy Lead
National Stroke Programme
Team
england.clinicalpolicy@nhs.net
Supporting Documents
Implementation guidance
SSNAP Guidance
Services in scope
Community with stroke
rehabilitation
Payment levels
Minimum: 35%
Maximum: 55%
Scope: Q1 Q2 Q3 Q4
www.nhs.uk
CCG10a: Ambulance - Access to Patient Information at
Scene (Assurance)
35
Data Source(s) & Reporting
Quarterly reporting about the number of providers that have successfully completed the
NHS Digital assurance process for enabling access tor patient information on scene, by
ambulance crews, as reported by NHS Digital.
Description
Achievement of NHS Digital’s assurance process for enabling access to patient
information on scene, by ambulance crews via one of the four nationally agreed
approaches:
a) SCRa Portal – a standalone web viewer, on the Spine web portal – controlled by smart
card
b) SCR 1-Click - Patient contextual click- launches the SCRa from within an existing
application.
• Known providers; Servelec RiO and Lorenzo (CSC)
c) Commercial Spine Mini Service Providers
• Known providers; Quicksilva and Intersystems
d) Direct Spine Integration by System Suppliers
• Known providers; Adastra (Advanced Health and Care), CLEO
(CLEOsystems24), Web (EMIS), Symphony (Ascribe), SystmOne (TPP)
Known suppliers for each route have been identified however other suppliers may exist or
enter the market during the lifetime of this CQUIN.
Accessing support
Policy Lead
Claire Joss
england.ambulance@nhs.net
Supporting Documents
Ambulance CQUIN Guidance
Workspace
(Please email UECP-
manager@future.nhs.uk to
request access.)
Services in scope
Ambulance
Payment levels
Minimum: 0% (failed
assurance)
Maximum: 100% (passed
assurance)
Scope: Q1 Q2 Q3 Q4
www.nhs.uk
CCG10b: Ambulance - Access to Patient Information at
Scene (Demonstration)
36
Data Source(s) & Reporting
Quarterly submission via National CQUIN collection from trust’s operational systems - see
sections 4.i. for details about auditing and 4.ii. for details on data collection and reporting.
Data will be made available approximately 6 weeks after each quarter.
Description
Achieving 5% of face to face incidents resulting in patient data being accessed by
ambulance staff on scene.
Numerator
Of the denominator, the number of incidents with a face to face response, during which the
ambulance staff on scene accessed the patient’s record.
Denominator:
Total count of incidents with a face to face response as defined in Ambulance Systems
indicator (item A56).
Accessing support
Policy Lead
Claire Joss
england.ambulance@nhs.net
Supporting Documents
Ambulance statistics
Ambulance Quality Indicators
Services in scope
Ambulance
Payment levels
Minimum: 0%
Maximum: 5%
Scope: Q1 Q2 Q3 Q4
www.nhs.uk
CCG11a: SDEC – Pulmonary Embolus
37
Data Source(s) & Reporting
Quarterly case note audit submitted via National CQUIN collection – see sections 4.i. for
details about auditing and 4.ii. for details on data collection and reporting. An auditing tool
and FAQs are available to support collection. Data will be made available approximately 6
weeks after each quarter.
Description
Achieving 75% of patients with confirmed pulmonary embolus (PE) being managed in a
same day setting where clinically appropriate.
Numerator
Of the denominator, those managed in a same day setting, as set out in NICE Guidance
CG144, and discharged to usual place of residence on the same day as
attendance/admission.
Denominator
Total number of patients attending A&E, aged 18+ with a primary diagnosis of pulmonary
embolus*, whose case notes indicate that same day care is clinically appropriate**.
*ICD-10 codes: I260, I269. SNOMED codes: 59282003
**Clinically appropriate criteria:
• No history of cancer
• No history of chronic cardiopulmonary (heart failure or chronic lung) disease
• Pulse less than 110 beats/ min
• Systolic Blood Pressure greater than 100mmHg
• Oxygen saturation level (arterial) greater than 90%
Exclusions
None
Accessing support
Policy Lead
Rachel Vokes
nhsi.sdeccquinsupport@nhs.n
et
Supporting Documents
NICE Guidance CG144
Ambulatory Emergency Care
Directory (6th Edition)
BTS Guidance for the
outpatient management of PE
SDEC Additional Resources
Services in scope
Acute with Type 1 Emergency
Department
Payment levels
Minimum: 50%
Maximum: 75%
Scope: Q1 Q2 Q3 Q4
www.nhs.uk
CCG11b: SDEC – Tachycardia with Atrial Fibrillation
38
Data Source(s) & Reporting
Quarterly case note audit submitted via National CQUIN collection – see sections 4.i. for
details about auditing and 4.ii. for details on data collection and reporting. An auditing tool
and FAQs are available to support collection. Data will be made available approximately 6
weeks after each quarter.
Description:
Achieving 75% of patients with confirmed atrial fibrillation (AF) being managed in a same
day setting where clinically appropriate.
Numerator
Of the denominator, the number of patients who are managed in a same day setting, as
set out in NICE Guidance CG180, and are discharged to usual place of residence on the
same day as attendance/admission.
Denominator
Total number of patients attending A&E, aged 18+, with a primary diagnosis of atrial
fibrillation*, whose case notes indicate that same day care is clinically appropriate**.
*ICD-10 codes: I44.0-7, I45.0-9 (excI I457), I47.0, 147.2, I47.9, I48.0-9, I49.1-2, I49.4-5,
I49.8-9, R00.0,R00.2,R00.8. SNOMED codes: 49436004
**Clinically appropriate criteria:
• No chest pain
• Systolic blood pressure greater than 100 mmHg
Exclusions
Supraventricular tachycardia, postural orthostatic tachycardic syndrome
Accessing support
Policy Lead
Rachel Vokes
nhsi.sdeccquinsupport@nhs.n
et
Supporting Documents
NICE Guidance CG180
Ambulatory Emergency Care
Directory (6th Edition)
SDEC Additional Resources
Services in scope
Acute with Type 1 Emergency
Department
Payment levels
Minimum: 50%
Maximum: 75%
Scope: Q1 Q2 Q3 Q4
www.nhs.uk
CCG11c: SDEC – Community Acquired Pneumonia
39
Data Source(s) & Reporting
Quarterly case note audit submitted via National CQUIN collection – see sections 4.i. for
details about auditing and 4.ii. for details on data collection and reporting. An auditing tool
and FAQs are available to support collection. Data will be made available approximately 6
weeks after each quarter.
Description
Patients with confirmed Community Acquired Pneumonia (CAP) should be managed in a
same day setting where clinically appropriate.
Numerator
Of the denominator, the number of patients who are managed in a same day setting, as
set out in NICE Guidance CG191, and are discharged to usual place of residence on the
same day as attendance/admission.
Denominator
Total number of patients attending A&E, aged 18+, with a primary diagnosis of
pneumonia*, whose CRB65 score is 0 -1 and whose case notes indicate that same day
care is clinically appropriate in accordance with BTS Guidance.
*ICD-10 codes: J10.0-J12.0-3, J12.8-9, J13x, J14x,J15.3-9, J16.0/8, J17.0-1, J17.8, J18.0-
1, J18.8-9. SNOMED codes: 278516003, 233604007, 50417007)
Exclusions
None
Accessing support
Policy Lead
Rachel Vokes
nhsi.sdeccquinsupport@nhs.n
et
Supporting Documents
NICE Guidance CG191
Ambulatory Emergency Care
Directory (6th Edition)
SDEC Additional Resources
Services in scope
Acute with Type 1 Emergency
Department
Payment levels
Minimum: 50%
Maximum: 75%
Scope: Q1 Q2 Q3 Q4
www.nhs.uk
Date Update
7th March 2019 Initial Publication
8th March 2019 p24 PICC Lines – Note added to confirm community inserted PICC lines only.
8th May 2019 p5-9 – General performance and payment slides expanded for clarity.
p10 – 4b Opening sentence clarified.
p14-15 – References updated, Diagnosis codes clarified, Sepsis exclusion clarified.
p16 – Clarified period in scope.
p32-34 – SDEC Additional Resources link added. Spelling mistake amended on p34.
17th June 2019 p32-34 – SDEC FAQs link added. Amended ICD-10 codes.
15th July 2019 p2 – Contents page amended.
p13-17 – Data collection and reporting section updated.
12th August 2019 p8 – Payment calculation figure error corrected.
p39 – SDEC CAP slide denominator section updated. BTS Guidance link added.
8th October 2019 p6 – Payment basis column amended
p19, 31 – Payments scope amended
3rd February 2020 P16 – Data revisions deadline windows amended.
40
Version Control
Recommended